Abstracts

Rationale: Medication side effects are a common problem in people living with epilepsy (PWEs), and some studies indicate that up to 31% of PWEs change medications for this reason. Switching medications can delay reaching a personalized, well-tolerated, anti-seizure medication regimen in a timely fashion. Creating an interactive dashboard could assist providers in medication decision-making and allow a more efficient process for determining a personalized medication regimen. Our project evaluated how an interactive dashboard can be used as a screening tool to describe the side effects of specific medications.

Methods: We developed and implemented an interactive dashboard to replace static population health reports for the Massachusetts General Hospital (MGH) Epilepsy Learning Healthcare System (ELHS) Team. The dashboard was created using the Tableau analytics platform and includes data visualizations for patient-reported outcomes (electronic questionnaires) collected between January 2019 and April 2024 via MGH’s patient portal and then queried by the ELHS Data Coordinating Center (DCC) from MGH’s electronic data warehouse. Questions include medication side effects, seizure control, and demographics as developed by ELHS.

Results: During the period in question, 3577 PWEs were captured, and 2782 questionnaires were completed. Commonly used drugs were levetiracetam (Keppra, Roweepra, Spritam), lamotrigine (Lamictal), and Lacosamide (Vimpat), while newer less frequently used drugs were cenobamate (Xcopri), cannabidiol (Epidiolex), and perampanel (Fycompa). Of those who completed their questionnaires, 611 were taking levetiracetam, 558 were taking lamotrigine, 344 were taking lacosamide, 95 were taking cenobamate, 39 were taking cannabidiol, and 8 were taking perampanel. For side effects, 17% of those taking levetiracetam reported side effects (n=101), 16% of those taking lamotrigine reported side effects (n=91), 25% of those taking lacosamide reported side effects (n=86), 26% of those taking cenobamate reported side effects (n=25), 13% of those taking cannabidiol reported side effects (n=5), and 63% of those taking perampanel reported side effects (n=5). For those with a seizure less than a year ago, 15% of patients taking levetiracetam, 23% of patients taking lamotrigine, 30% of patients taking lacosamide, 45% of patients taking cenobamate, 44% of patients taking cannabidiol, and 100% of patients taking perampanel had side effects. For those with a seizure more than a year ago, 12% of patients taking levetiracetam, 10% of patients taking lamotrigine, 22% of patients taking lacosamide complained of side effects.

Conclusions: This interactive dashboard can help screen PWEs to identify those with side effects to certain medications, which can differ by degree of seizure control; this could allow for more informed decision-making on balancing side effects and seizure control for future medication trials.

Funding: Epilepsy Learning Healthcare System, an Epilepsy Foundation of America program.